Comfort care; End of life - palliative care; Hospice - palliative care
The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and treatment. Palliative care also treats emotional, social, practical, and spiritual problems that illnesses can bring up. When the person feels better in these areas, they have an improved quality of life.
Palliative care can be given at the same time as treatments meant to cure or treat the disease. Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life.
Palliative care may be offered for people with illnesses, such as:
- Heart disease
- Lung diseases
- Kidney failure
- ALS (amyotrophic lateral sclerosis)
While receiving palliative care, people can remain under the care of their regular provider and still receive treatment for their disease.
Any health care provider can give palliative care. But some providers specialize in it. Palliative care may be given by:
- A team of doctors
- Nurses and nurse practitioners
- Physician assistants
- Registered dietitians
- Social workers
- Massage therapists
Palliative care may be offered by hospitals, home care agencies, cancer centers, and long-term care facilities. Your provider or hospital can give you the names of palliative care specialists near you.
The Difference Between Palliative Care and Hospice
Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness.
Hospice care is most often offered only when the person is expected to live 6 months or less.
What Does Palliative Care Include?
A serious illness affects more than just the body. It touches all areas of a person's life, as well as lives of that person's family members. Palliative care can address these effects of a person's illness.
Physical problems. Symptoms or side effects include:
Treatments may include:
- Nutritional guidance
- Physical therapy
- Occupational therapy
- Integrative therapies
Emotional, social, and coping problems. Patients and their families face stress during illness that can lead to fear, anxiety, hopelessness, or depression. Family members may take on care giving, even if they also have jobs and other duties.
Treatments may include:
- Support groups
- Family meetings
- Referrals to mental health providers
Practical problems. Some of the problems brought on by illness are practical, such as money- or job-related problems, insurance questions, and legal issues. A palliative care team may:
- Explain complex medical forms or help families understand treatment choices
- Provide or refer families to financial counseling
- Help connect you to resources for transportation or housing
Spiritual issues. When people are challenged by illness, they may look for meaning or question their faith. A palliative care team may help patients and families explore their beliefs and values so they can move toward acceptance and peace.
Tell your provider what bothers and concerns you most, and what issues are most important to you. Give your provider a copy of your living will or health care proxy.
Ask your provider what palliative care services are available to you. Palliative care is almost always covered by health insurance, including Medicare or Medicaid. If you do not have health insurance, talk to a social worker or the hospital's financial counselor.
Learn about your choices. Read about advance directives, deciding about treatment that prolongs life, and choosing not to have CPR (do not resuscitate orders).
House SA. Palliative and end-of-life care. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:41-46.
Oxenham D. Palliative care and pain. In: Walker BR, Colledge NR, Ralston SH, Penman ID, eds. Davidson's Principles and Practice of Medicine. 22nd ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 12.
Rakel RE, Trinh TH. Care of the dying patient. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 5.
Schaefer KG, Abrahm JL, Wolfe J. Palliative care. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 92.